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The need for better management of chronic conditions is urgent. About 141 million people in the United States were living with one or more chronic conditions in 2010, and this number is projected to increase to 171 million by 2030. To address this challenge, many health plans have piloted and rolled out innovative approaches to improving care for their members with chronic conditions. This report documents the current range of chronic care management services, identifies best practices and industry trends, and examines factors in the plans' operating environment that limit their ability to optimize chronic care programs. The authors conducted telephone surveys with a representative sample of health plans and made in-depth case studies of six plans. All plans in the sample provide a wide range of products and services around chronic care, including wellness/lifestyle management programs for healthy members, disease management for members with common chronic conditions, and case management for high-risk members regardless of their underlying condition. Health plans view these programs as a "win-win" situation and believe that they improve care for their most vulnerable members and reduce cost of coverage. Plans are making their existing programs more patient-centric and are integrating disease and case management, and sometimes lifestyle management and behavioral health, into a consolidated chronic care management program, believing that this will increase patient engagement and prevent duplication of services and missed opportunities.

Table of Contents

Chapter One

Introduction

Chapter Two

Program Prevalence

Chapter Three

Program Design

Chapter Four

Member Interaction

Chapter Five

Coordinating Plan and Provider Activities

Chapter Six

Chronic Care Management Program Evaluation

Chapter Seven

Challenges To Chronic Care Management Program Success

Chapter Eight

Conclusions

Appendix A

Detailed Results from Survey

Appendix B

Case Studies

The research described in this report was sponsored by the America's Health Insurance Plans Foundation, and was produced within RAND Health, a division of the RAND Corporation.

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